Citing discontent with the precision of the K-level system (the Medicare Functional Classification Levels) to classify patients with limb loss and the movement toward evidence-based practice, a team of researchers sought to develop a clinical practice recommendation for exercise testing in prosthetic patient care based on the results of a systematic literature review. They found that while the results of the review did not support a direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics.
A multidisciplinary team developed the methodology and guideline development. The team reviewed articles from PubMed, Google Scholar, Web of Science, and Cochrane, with a range of publication dates from December 2001 through December 2016. Of a potential 1,386 articles located, ten met the criteria for inclusion. The articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Data from the articles was synthesized into six empirical evidence statements, which were used to develop the proposed clinical practice guideline.
The results indicated that a subject’s ability to sustain at least 50 percent VO2max (the maximum amount of oxygen that the subject could utilize during maximal exercise) is likely an indicator for successful prosthetic ambulation in elderly subjects with an amputation proximal to the knee, which the researchers concluded would predict prosthetic ambulatory success in younger subjects and people with more distal amputation levels. The researchers also concluded that the ability of an older individual with a unilateral hip disarticulation to sustain an exercise intensity of at least 60 percent VO2max indicated the anticipated ability to successfully use a prosthesis at the community ambulation level. VO2 values were also found to increase in the subjects following a six-week exercise program.
The open-access study was published September 5 in the Journal of NeuroEngineering and Rehabilitation’s supplement, “Advancements in Prosthetics and Orthotics: Selected articles from the Second World Congress hosted by the American Orthotic & Prosthetic Association (AOPA).”